Healthcare Provider Details

I. General information

NPI: 1255778601
Provider Name (Legal Business Name): KERRI-ANN O'HALLORAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HAMILTON PL
GARDEN CITY NY
11530-5937
US

IV. Provider business mailing address

112 CAMBRIDGE AVE
STEWART MANOR NY
11530-5046
US

V. Phone/Fax

Practice location:
  • Phone: 917-691-0156
  • Fax:
Mailing address:
  • Phone: 917-691-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: